Treatment of osteoporosis has advanced dramatically during the past decade, with more therapeutic options than ever now available. Large-scale randomized placebo-controlled trials have documented the efficacy of a number of agents in reducing vertebral and non-vertebral fractures. Anti-resorptive agents (hormone replacement therapy, selective estrogen-receptor modulators, calcitonin and bisphosphonates) and bone-forming anabolic agents (parathyroid horomone and strontium ranelate) act via different mechanisms to reduce fractures and improve bone strength. In view of the high prevalence of calcium and vitamin D insufficiency in Asia, calcium and vitamin D supplementation remains a fundamental part of any treatment regimen, especially among the elderly. Given the high cost of these agents, a global assessment of the fracture risk of the patient is essential to determine the need for pharmacological treatment versus life-style modification and dietary supplementation in the management of postmenopausal osteoporosis in Asia.